Hemifacial Paralysis Research Articles

Routine Dental Procedure Induced Hemifacial Paralysis—Case Report

Routine Dental Procedure Induced Hemifacial Paralysis—Case Report

Intracranial malignant peripheral nerve sheath tumor: A case report and comprehensive literature review.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare malignant soft-tissue sarcomas arising from peripheral nerves. Little data exist regarding MPNST originating intracranially. Here, we present a 7th/8th nerve complex MPNST, discuss the treatment strategy and patient outcome, and provide a comprehensive review of existing literature. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and crossed references were queried, yielding 37 publications from 1952 to the present. Fifty-three cases of primary intracranial and extra-axial MPNST were identified. We additionally report a 40-year-old female presented with acute onset dizziness and subsequent hearing loss with associated right-sided facial numbness. Magnetic resonance imaging revealed a 0.5 cm × 1.7 cm enhancing lesion within the right internal auditory canal extending into the cerebellopontine angle. The patient was initially treated with retro sigmoid craniotomy for tumor resection followed by a trans labyrinth approach for residual tumor resection. She completed adjuvant fractionated radiation therapy and underwent facial nerve transfer to restore complete hemifacial paralysis. The most common cranial nerves involved were V and VIII (43.4% each), with 66% of patients male and 34% female. The average age was 43.4 ± 17.4 years. The mean survival time for reported non-survivors after tissue diagnosis was 15 ± 4 months. Two-year survival for patients receiving gross total resection was 33.3% versus 22.8% with subtotal resection. MPNSTs comprise a group of highly aggressive neoplasms that rarely arise intracranially. Gross total surgical resection should be pursued when feasible.

Complete Hemifacial Paralysis Post-facelift: Making Sense of a Plastic Surgeon's Worst Nightmare.

Postrhytidectomy hemifacial paralysis is a frightening clinical condition affecting the proximal facial nerve and most often associated with Bell's palsy. Associated symptoms are common and include auditory, salivary, vestibular, and gustatory complaints. The aim of the study was to provide increased awareness of postrhytidectomy hemifacial paralysis secondary to Bell's palsy in the plastic surgery community. Following a roundtable discussion with the senior author's (J.C.G.) plastic surgery colleagues located all over the world, 8 surgeons reported having had firsthand experience with hemifacial paralysis in patients following facelift. Descriptions of their cases, including preoperative, intraoperative, and postoperative courses were collected and reported. A total of 10 cases of postrhytidectomy hemifacial paralysis were analyzed based on results of a clinical questionnaire. Eight of the 10 cases involved all facial nerve branches, with 2 cases sparing the marginal mandibular branch. The vast majority of cases were referred to a neurologist and steroids initiated. Two patients were returned to the operating room for exploration. Associated symptoms reported included pain in the ear, hearing loss, ocular symptoms such as tearing or dryness, vestibular symptoms such as vertigo, changes in taste, and in 1 patient an electric-shock type sensation to the face. Hemifacial paralysis associated with Bell's palsy following rhytidectomy is a rare but known clinical entity that should be included in the preoperative informed consent process before facelift. Current management trends are neurology referral and steroid initiation.

An interesting case of crossed syndrome: ipsilateral facial paralysis with contralateral glossoplegia

BackgroundStroke is rarely accompanied with peripheral facial paralysis and supranuclear palsy of the hypoglossal nerve. Both sides of the motor cortex innervate the hypoglossal nucleus; therefore, unilateral lesions of the upper motor neurons rarely result in contralateral lingual paresis. We report a rare case of crossed syndrome with associated hyperacute peripheral hemifacial paralysis and contralateral lingual paresis after a lower pontine tegmentum ischemic stroke.Case presentation: A 73-year-old man presented with symptoms of hyperacute peripheral hemifacial paralysis. Upon protrusion, the patient’s tongue deviated to the contralateral side, without fasciculation or atrophy. Brain imaging showed focal ischemic stroke in the pontine tegmentum. However, lingual hemiparesis and multimodal neuroimaging findings differed.ConclusionsWe suggest that cortico-hypoglossal fibers pass through the dorsal pontine. This case of crossed syndrome is a rare report of a lower pontine tegmentum ischemic stroke resembling an upper motor neuron lesion of the contralateral hypoglossal nerve.

Management of Ardita in Ayurveda: A Case Study

Aggravated Vata, affects face & leads to impaired function of facial muscle. The term Ardita denotes facial paralysis or Bell’s palsy. Ardita comes under eighty Nanatmaja Vyadhi. Facial palsy is most common neurological disorder, in which seventh cranial nerve is affected. The facial nerve conveys both sensory & motor along with parasympathetic fibres. Damaged facial nerve (VII) results in loss of function of facial muscle leads to cosmetic impairment. In this manuscript we are presenting a case study of a 38 years old male patient with left LMN left hemifacial palsy with symptoms of weakness in the left side of body, drooping of angle of mouth towards the left side, difficulty in speech, difficulty in wrinkling of forehead in left side, lacrimation from left eyes, numbness in left side of face, altered sensation of taste. Ayurvedicformulations like Vatavidhwansa rasa, ekangavir rasa, jivhadikashayaetc along with the Panchkarma procedure has been given and treated for one week. Patient got complete relief with appreciable changes in all symptoms.

Right Hemifacial Paralysis in a 6-Year-Old Boy: An Overlooked Case Report of Bell’s Palsy in Children

This study focuses on a case of Bell's Palsy in a 6-year-old boy. Bell's Palsy is the most common type of facial nerve paralysis in children. The causes can be either congenital factors (traumatic malformations, symptomatic, non-syndromic, or hereditary conditions) or acquired factors (infections, inflammations, neoplastic, or traumatic factors). Bell's Palsy is commonly caused by viral infections, especially the herpes simplex virus. In this case, a child experienced rapid-onset right hemifacial paralysis, and he had no history of trauma or other systemic symptoms. A diagnosis of Bell's Palsy was made, and the child received treatment with corticosteroids and a rehabilitation program. The results of this study indicate that treatment with methylprednisolone for 3 days and a rehabilitation program involving relaxation exercises and massages to reduce muscle stiffness yielded a good response. Proper clinical observation and evaluation are crucial in diagnosing Bell's Palsy in children. A multidisciplinary approach through collaboration between pediatricians and physiotherapists plays a significant role in managing such cases. Good follow-up is necessary to reduce the risk of prolonged facial nerve paralysis in the future.

COVID-19 and Bell’s Palsy

There are various neurological manifestations of coronavirus disease 2019 (COVID-19). Recent data suggest a connection between hemifacial paralysis, or Bell’s palsy, and COVID-19. Although the etiology of Bell’s palsy is unknown, the leading proposed etiology is viral in nature. Since the onset of the pandemic, numerous studies have investigated the relationship between Bell’s palsy, COVID-19 infection, and COVID-19 vaccination. The researchers studied the current literature on the topic of COVID-19 as it relates to Bell’s palsy.

New evidence of photobiomodulation and ozone therapy combined in the treatment of Bell's palsy

Bell's palsy is the most common cause of unilateral facial palsy reported in the literature. This condition consists of causing rapid onset and unilateral peripheral paresis/paraesthesia of the seventh cranial nerve. Despite being well documented, its etiology is still uncertain, imposing difficulty in immediate treatment. The combination of laser therapy and ozone therapy was proposed as a new treatment method for Bell's palsy, as it combines the efficacy and response of a therapy with the benefits of a minimally invasive approach. In the present study, we describe the first treatment protocol combining laser therapy and ozone therapy in Brazil, as well as details of the technique for the treatment of Bell's palsy. Case Report: A 59-year-old female with paralysis and paresthesia in the right hemiface, diagnosed for Bell's palsy, underwent a combined treatment of laser therapy and ozone therapy (VK OzonTherapy). After the fourth treatment session, a great clinical response was observed, and another session of the VK OzonTherapy protocol was performed. The patient evolved with significant improvement in the sequelae of right hemifacial paralysis, oro-ocular and eye closure, with rapid recovery of muscle tone and correction of asymmetries. Conclusions: This Report shows that the VK OzonTherapy protocol is an adjunct tool for clinical practice capable of improving the aesthetic-functional quality of life in patients with recent unilateral facial palsy.

Bell felcinin viral patojenitesi ve tedavi olarak botulinum toksin tip A kullanımı

Bell’s palsy is the common name for the inflammation of the cranial nerve VII. The peculiar geniculate ganglion inflammation is idiopathic and causes hemifacial paralysis. Patients who suffer from this paralysis may have their symptoms dissipate between 3 weeks and 3 months. For certain patients whose facial paralysis persist, botulinum toxin type- A might be an efficient treatment. Depending on the severity of the muscular palsy, different treatments can be offered including surgery, steroid, and anti-viral treatment as well as Botox. This review article’s purpose is to dive into the possible correlation of viral pathogens with the activation of the facial nerve inflammation, and how patients with Bell’s palsy can benefit from Botox type-A as treatment.

A Clinical Approach to Ardita (Facial Palsy) through Ayurveda: A Single Case Study

Aggravated Vata, affects face & leads to impaired function of facial muscle. The term Ardita denotes facial paralysis or Bell’s palsy. Ardita comes under eighty Nanatmaja Vyadhi. Facial palsy is most common neurological disorder, in which seventh cranial nerve is affected. The facial nerve conveys both sensory & motor along with parasympathetic fibres. Damaged facial nerve (VII) results in loss of function of facial muscle leads to cosmetic impairment. In this manuscript we are presenting a case study of a 44 years old female patient with left LMN left hemifacial palsy with symptoms of weakness in the left side of body, drooping of angle of mouth towards the left side, difficulty in speech, difficulty in wrinkling of forehead in left side, lacrimation from left eyes, numbness in left side of face, altered sensation of taste. Ayurvedic & Herbal formulations like Buhat Vata Chintamani ras, Giloy Satva, Ashwgandha Churna, Trayodhashang Gugulu, etc along with the Panchkarma procedure has been given and treated for one week. Patient got complete relief with appreciable changes in all symptoms.

Assessing anxiety, depression and quality of life in patients with peripheral facial palsy: a systematic review.

ObjectivePeripheral facial palsy (PFP) is predominantly a unilateral disorder of the facial nerve, which can lead to psychological disorders that can result in decreased quality of life. The aim of this systematic review was to assess anxiety, depression and quality of life symptoms associated with PFP.Data sourcesWe searched the Medline, PEDro, CINAHL and Google Scholar databases to conduct this systematic review while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The search was performed by two independent reviewers, and differences between the two reviewers were resolved by consensus.Study SelectionThe search terms used were derived from the combination of the following MeSH terms: “facial paralysis”, “bell palsy”, “anxiety”, “anxiety disorders”, “depression”, “depressive disorders”, “quality of life” and not MeSH: “facial palsy”, “hemifacial paralysis”, “facial paresis”, “Peripheral Facial Paralysis”, using the combination of different Boolean operators (AND/OR).Data ExtractionOn November 1st (2019).Data SynthesisIn total, 18 cross-sectional articles and two case-control studies were selected.ConclusionsThe cross-sectional articles showed low methodological quality, while the case-control studies showed acceptable methodological quality. Limited evidence suggests that patients with PFP might have increased levels of anxiety and depressive symptoms. A qualitative analysis also showed limited evidence that quality of life might be diminished in patients with PFP.PROSPEROCRD42020159843.

Toxina botulínica para correção de assimetria facial pós AVC: relato de caso clínico

Introdução: A paralisia facial, é caracterizada pela incapacidade de movimentar os músculos faciais, que são responsáveis pela mímica facial, isso ocorre devido a uma lesão causada no nervo facial (VII) par de nervo craniano. No que diz respeito às causas de assimetrias faciais podem ser multifatoriais, podendo ser de origem congênita, adquirida (devido a lesões ou doenças), e de desenvolvimento. O uso da toxina botulínica, tem sido uma grande aliada uma vez que, proporciona benefícios para os tratamentos estéticos realizados por profissionais especializados. Objetivo: Dessa forma, o objetivo deste trabalho é relatar um caso clínico sobre a aplicação de toxina botulínica para correção de assimetria facial por paralisia pós AVC. Metodologia: Trata-se de um estudo de abordagem descritiva do tipo relato de caso clínico realizado em consultório odontológico na cidade de Maceió-AL. Relato de caso: Paciente NLFS, professora, sexo feminino, 45 anos, compareceu ao consultório no dia 21/01/2020 para fazer avaliação, a paciente relatou a seguinte queixa principal: assimetria facial devido a paralisia hemifacial no lado esquerdo do rosto. Conclusão: Todavia pode-se concluir que o tratamento com Toxina Botulínica-A foi eficaz para devolver estética, simetria, função e equilíbrio muscular à face da paciente.

Medial Pontomedullary Stroke Mimicking Severe Bell's Palsy: A Case Report.

IntroductionPatients with acute unilateral upper and lower facial palsy frequently present to the emergency department fearing they have had a stroke, but many cases are benign Bell’s palsy.Case ReportWe present a rare case of a medial pontomedullary junction stroke causing upper and lower hemifacial paralysis associated with severe dysphagia and contralateral face and arm numbness.ConclusionAlthough rare, pontine infarct must be considered in patients who present with both upper and lower facial weakness. Unusual neurologic symptoms (namely diplopia, vertigo, or dysphagia) and signs (namely gaze palsy, nystagmus, or contralateral motor or sensory deficits) should prompt evaluation for stroke.

APPROACH OF CLINICAL MANIFESTATIONS OF RAMSAY HUNT SYNDROME TYPE II IN THE MAXILLOFACIAL COMPLEX IN ONCOLOGICAL PATIENT

Ramsay Hunt syndrome is characterized by hemifacial paralysis of peripheral nerves, otitis, and ipsilateral redness in the auricle. A female patient in the seventh decade of life undergoing chemotherapy treatment for adenocarcinoma of the endometrium presented ipsilateral hemifacial paralysis, referring odynophagia, dysphagia, and dysphonia. Clinical examination revealed ulcerations and blistering lesions with crust formation in the left auricular pavilion as well as surrounding erythema on the skin, such manifestations also present in the cervical and cranial regions. Intraoral examination presented numerous herpetic erosions in the palatal and lingual region only on the left side. From the clinical and imaging findings, the diagnosis of Ramsay Hunt syndrome type II was established. The treatment was performed using acyclovir, laser therapy (low-intensity laser), and oral hygiene with 0.12% chlorhexidine digluconate. After 45 days of treatment, the patient had complete remission of the herpetic lesions, but hemiparalysis did not have a complete regression.

Pseudotumor hemofílico de fosa posterior como forma de presentación de hemofilia en paciente pediátrico. Reporte de caso y revisión

Paciente masculino de 10 meses es ingresado por parálisis hemifacial y hemiparesia derecha de un mes de evolución. En su exámen neurológico se observa con dismetría y lateropulsión derecha. El estudio de resonancia magnética se observa con una lesión intradural extraxial con efecto de masa y erosión de la escama occipital, con oclusión del seno transverso. Por tiempo de tromboplastina prolongado se protocoliza con diagnóstico de Hemofilia A leve (activida de factor VIII 12,8%). Se realiza reposición de factor VIII con posterior resección de la lesión. El estudio histopatológico revela hematoma subdural crónico. El paciente evoluciona favorablemente por lo que se egresa posteriormente. El pseudotumor hemofílico debe considerarse parte de los diagnósticos diferenciales de las lesiones intracraneales en paciente hemofílicos.

Intraoral Administration of Botulinum Toxin for Continuous Dentoalveolar Neuropathic Pain: A Case Series.

To examine the analgesic effect, safety, and tolerability of intraoral administration of onabotulinum toxin A (BoNT/A) in patients suffering from intractable continuous dentoalveolar neuropathic pain. Eight patients (six women and two men) of ages ranging from 21 to 73 years (mean [standard deviation] 52.4 [16.1] years) suffering from continuous dentoalveolar pain for a mean duration of 5.8 (4.4) years received a submucosal injection of 10 to 25 units of BoNT/A into the vestibular mucosa surrounding the painful site. Pain intensity levels were recorded using a verbal rating scale (VRS). Safety and tolerability of BoNT/A were measured based on patient self-report, including any adverse effects reported by the patient at the injection site. Five of eight patients reported positive pain reduction. In this group, mean pain intensity on a 0-10 VAS was 4.8 (2.2) at baseline and 2.6 (2.1) at postinjection. The analgesic effect was maximal between 7 and 14 days postinjection and lasted for 1 to 8 weeks before subsequently returning to the pre-injection levels. No adverse effects were reported at the injection sites. One patient noted transient partial hemi-facial paralysis. These results suggest the potential therapeutic benefit of BoNT/A in the management of continuous dentoalveolar neuropathic pain. Further investigations conducted via well-controlled studies in the area of orofacial pain are warranted.

Toward the Bionic Face: A Novel Neuroprosthetic Device Paradigm for Facial Reanimation Consisting of Neural Blockade and Functional Electrical Stimulation.

Facial palsy is a devastating condition potentially amenable to rehabilitation by functional electrical stimulation. Herein, a novel paradigm for unilateral facial reanimation using an implantable neuroprosthetic device is proposed and its feasibility demonstrated in a live rodent model. The paradigm comprises use of healthy-side electromyographic activity as control inputs to a system whose outputs are neural stimuli to effect symmetric facial displacements. The vexing issue of suppressing undesirable activity resulting from aberrant neural regeneration (synkinesis) or nerve transfer procedures is addressed using proximal neural blockade. Epimysial and nerve cuff electrode arrays were implanted in the faces of Wistar rats. Stimuli were delivered to evoke blinks and whisks of various durations and amplitudes. The dynamic relation between electromyographic signals and facial displacements was modeled, and model predictions were compared against measured displacements. Optimal parameters to achieve facial nerve blockade by means of high-frequency alternating current were determined, and the safety of continuous delivery was assessed. Electrode implantation was well tolerated. Blinks and whisks of tunable amplitudes and durations were evoked by controlled variation of neural stimuli parameters. Facial displacements predicted from electromyographic input modelling matched those observed with a variance-accounted-for exceeding 96 percent. Effective and reversible facial nerve blockade in awake behaving animals was achieved, without detrimental effect noted from long-term continual use. Proof-of-principle of rehabilitation of hemifacial palsy by means of a neuroprosthetic device has been demonstrated. The use of proximal neural blockade coupled with distal functional electrical stimulation may have relevance to rehabilitation of other peripheral motor nerve deficits.

A wearable soft robot for movement assistance on eyelid closure

We present a facial wearable robot to support eyelid movement for patients with hemifacial paralysis. People with facial paralysis are not able to blink, which leads to dry eyes and could cause permanent damage to the cornea. To address this issue, we developed a robotic system to support eyelid movement on the paralyzed side based on voluntary eyelid movement on the healthy side. The robot has a novel mechanism for supporting eyelid movement and is made from soft material, which we call the eyelid gating mechanism (ELGM). We defined the requirements for eyelid manipulation. Then, we introduced design rules for the ELGM based on this definition, and conducted a deformation analysis. As a result, we could control deformation so that it is tailored to eyelid movement with simple rotational input at two hinged ends. This system provides appropriate support for eyelid movement in a non-invasive and gentle manner, based on voluntary eyelid movement on the healthy side. In this paper, we present a performance evaluation of the developed ELGM and the wearable facial robot. We confirm that ELGM could aid eyelid closure in 8 out of 10 patients. Further, we find that the time lag between eyelid closure detection and completion was 236.9 pm 19.4 ms.

74. Brainstem excitability in Hemifacial Spasm and Post-Facial Palsy Synkinesias and effects of botulinum toxin

Hemifacial Spasm (HFS) and Post-Facial Palsy Syndrome (PFPS) are characterised by synkinesias which electrophysiological hallmark is the lateral spread of the blink reflex, but functional and anatomical evidence of this phenomenon is lacking. To evaluate brainstem excitability in the facial and trigeminal pathways of the affected and unaffected side in HFS and PFPS and modifications induced by botulinum toxin treatment (BoNT-A). The Blink Reflex (BR), BR Recovery Cycle (BRRC) and Masseter Inhibitory Reflex (MIR) were assessed in HFS (n = 10) and PFPS (n = 7), before and after BoNT-A. Facial palsy (FP; n = 4), used as lesional model, and healthy controls (n = 8), were also assessed. BR and MIR were normal in all groups. In all patients BRRC analysis revealed a central hyperexcitability pattern following direct and indirect stimulation on both affected (p = 0.000007) and unaffected (p = 0.00007) sides, with highest effect at 500 ms interstimulus interval. BoNT-A injection did not affect this pattern in all patient groups. These preliminary results may indicate a brainstem compensatory attempt in response to a facial damage which is severe and temporary in PFPS and subtler but persistent in HFS. Central effects of BoNT-A should be searched at a higher level than the brainstem.

Extreme volume expansion of a vestibular schwannoma due to intratumoral hemorrhage after gamma knife radiosurgery

A 48-year-old man with right hemi-facial palsy and cerebellar ataxia was referred to our hospital. Three years and 10months earlier he had undergone gamma knife radiosurgery (GKRS) at the referring hospital for an 18mm right vestibular schwannoma. Slight tumor enlargement had been observed on MRI performed at the referring hospital 3years after the GKRS. On close follow-up after another 6months an MRI showed an obvious enlargement of the tumor. An MRI on admission revealed an iso-intense mass lesion measuring 36mm in maximum diameter at the right cerebellopontine angle. A two stage surgery was conducted using a retrosigmoid approach because bleeding from the tumor wall was difficult to control intraoperatively during the first operation. At the second operation, the majority of the tumor capsule had converted to necrotic tissue. A large hematoma cavity was present inside the tumor capsule which explained the rapid increase in size over a short period of time. Near total removal was achieved. Histopathological examination revealed massive intratumoral hemorrhage within a typical vestibular schwannoma with no malignancy. The complication of intratumoral hemorrhage is very rare and the utility of stereotactic radiation surgery/therapy, including GKRS, for vestibular schwannoma is well known. However, we must emphasize that careful follow-up is still required, even after several years.